Wednesday, November 20, 2013

Some of the lessons learned from the ICD-10 National Pilot Program include:

•Coders often confused the number “0” (zero) with the letter "O.”

•Coders often confused the number “1” (one) with the letter “l” (L).

•The average accuracy of the coders was 63% based on what was documented from the medical records

•Accuracy was determined based on the answers submitted via the coding response workbook. Answers were determined from matching the answer key to the answers provided by the testing organizations. A grading sheet was used to record the answers provided in comparison to the answer key. Each correct answer was assigned a zero (0) or a one (1) to come up with the % of correct answer.

•Out of the 485 coding submissions from all testing organizations, only 261 submissions by coders of testing organizations included information on time spent coding each medical test case. In addition, the coding process was limited by several variables including logistics.

•Variations in procedure codes were observed due to the expansion of those codes

•Missing procedure codes - occasionally coders coded the diagnosis only but forgot to code the procedures

•Most errors were functional – for example, records not being coded completely or codes being associated with the wrong medical test case numbers.

•Some coders did not specify type of chest pain – what was in the EMR/chart that differentiated it from atypical pains?

•Occasionally coders relied too much on the encoder instead of using their code books—errors occurred when coders went on “auto pilot” mode instead of referring to their code book. This is a problem today that will not necessarily go away with ICD-10.

•Coders should not become so dependent on encoders that they forget when/if there is a need to override.

•Coders were using a non-specific code for a fracture—not allowed in ICD-10-PCS if the diagnostic test results are documented

•Many coders forgot laterality, particularly in the case of pain in a limb; for this diagnosis, four coders out of eight received a zero.

•Coders averaged two medical records per hour, compared to four per hour under ICD-9, which translates to a 50% decline in productivity.

•Coding assignment showed variances which were influenced by hospital policies (ex. Some hospitals coded everything; others coded only what was relevant to the principal diagnosis)

•Logistical issues may have affected the coding time— medical test cases were uploaded into the system right side up but sometimes upside down, and sideways. These limitations and unusual circumstances made it difficult for coders to process the records quickly and therefore could have added to the time it took to code the medical test cases.

•Limitations and challenges include coder conflicts with own work load and personal schedules

•Working with limited resources using only in-kind donations affected the timelines and scope

•Technical/logistical issues in uploading coder responses within the Share Point work book slowed down the testing process

•Testing organizations that were fully electronic (EMR fully implemented) had difficulty coding medical records that were hand written—these groups found little value in documents that were not electronically generated.

Earlier this year, 498 asthma patients in California were split into two test groups. One group puffed their inhalers normally. But the second group was given a sensor that attaches to the top of the inhaler and beams data about their usage back to Dr. Rajan Merchant of Woodland Health Care. Each day, Dr. Merchant scans a list of several hundred patients to find the handful that need to be contacted for an office follow-up.

“Whenever there was a change in patients that require care, we would contact them either on the phone or have them come in,” Merchant told Fast Company. The patients in the control group also received sensors, but neither they nor their doctors were given access to the data. “We would see as them as usual when their symptoms were triggered or for their scheduled appointments.”

Propeller Sensor

This is one of the earliest clinical trials that will show how the so-called Internet of things--a vast array of small but interconnected devices that allow unprecedented levels of communication--could have an impact far more meaningful than automating your home lighting system. The asthma sensor is made by Propeller Health, and it recognizes what type of medication is being used, along with when and where symptoms are triggered. The data is shared with an app that tracks where and when each puff of medicine is discharged, and users can receive weekly updates via text message. It also tracks symptoms, triggers, and location, triangulating them so that you and your doctor can start to see what causes attacks. Are you in a high smog area? Is your bedroom too dusty? Do you use the rescue medication more in September when you’re burning leaves?

When you use the rescue medication it sends a text. 'We see you used your rescue information. We hope you’re okay.'

“The app prompts you for triggers," says Propeller's chief marketing officer Erica St. Angel. "When you use the rescue medication it sends a text, 'We see you used your rescue information. We hope you’re okay--when you’re feeling better, enter your trigger information. Like were you near a cat, was there mold, or was it cold outside?'" Over time that helps patients get smarter about when to take a preemptive puff.

Collecting and analyzing data from multiple individual asthmatics in a community unlocks another layer of potential for Propeller as well. The company partnered with the Weather Channel to monitor the air quality index in cities like Louisville, Kentucky, where they also teamed up with the city to give out free sensors to residents with asthma. “With many more users you can start to overlay other types of geospatial information, pollution, where the parks are, and create really dense and cool maps,” St. Angel says. “In Louisville you start to see time-based information--there is construction on the freeway right now, so asthma attacks are up.”

Around 26 million people suffer from asthma in the United States, according to the Centers for Disease Control (CDC). The annual cost of treating this condition is estimated at $50 billion. It has been calculated that if patient treatment could be better monitored, 80% of all asthma-related hospitalization could be avoided, and the mortality rate from asthma could be reduced by 20%.

Propeller's solution works even for people without smartphones. Through a partnership with Qualcomm Life, the inhaler sensor can be paired with a hub that plugs into the wall and transmits data. Patients using the hub receive an email with updates about their health. Propeller will even mail updates to people without Internet access. "Or we do phone calls," says Propeller CEO and cofounder David Van Sickle. "We have an asthma educator on staff for that reason.”

“I can care less about the technology,” Van Sickle says. “What we care about is improving outcomes to give people more asthma-free days.”

The early results show that the sensor is having a positive effect. Dr. Merchant, who has no financial relationship to Propeller or the foundation funding the study, released the first set of findings last week. Patients using the Propeller sensor on their inhalers had slightly fewer emergency room visits than the control group (0.103 versus 0.141 per person per year), and significantly fewer inpatient days (0.087 per person versus 0.225 among the control group).

Patients being monitored remotely with the Propellor sensors saved nearly $700 compared to the previous year for the same patients.

While that impact may appear to be small, it is measurable when applied to health spending, which is also being tracked historically for the test groups. The patients being monitored remotely with the Propellor sensors were on track to save nearly $700 compared to the previous year. “That was the biggest advantage,” says Merchant. “Both the hospital visits and the costs.”

The Propeller study is still young--this is the first quarter worth of results, and it doesn't wrap up until May of next year--but these are promising early results. And there's built-in incentive for doctors and hospitals to adopt the system. Regulatory changes taking effect in 2014 will, under Medicare's Hospital Readmissions Reduction Program, financially penalize hospitals that readmit patients with the chronic lung disease COPD within 30 days of their original stay. In January, Propeller is introducing a version of their sensor and app made specifically for patients suffering from COPD. “If you go to the hospital for COPD and are discharged but have to come back, there are penalties for the hospital--even if you go home stable,” says St. Angel. “This creates a driver for physicians to use the app to monitor and understand what is going on in the home environment.”

The British government is proposing a new law that could jail doctors and nurses for up to five years, if they are convicted of "willful negligence." The health secretary says the goal would be to prioritize patient safety.

The proposed legislation is part of new proposals meant to address problems revealed by a series of catastrophic failures at a hospital in central England, where hundreds of patients died unnecessarily.

In a speech in the British House of Commons on Tuesday, Health Secretary Jeremy Hunt said there is a need for a "profound transformation" in the culture of the government's free health care system.

But some doctors' groups said such a law would make health professionals defensive and fearful, and that measures already are in place to deal with negligent care.

William Considine, the president and CEO of Akron Children's Hospital moderates the panel discussion Healthcare Careers after the Full Implementation of the Affordable Care Act with panelists Martin Hauser, the CEO of SummaCare, Beverly Bokovitz, the Chief Nursing Officer for the Akron General Medical Center and Charles T. Taylor, the Dean of the College of Pharmacy at NEOMED at the University of Akron Taylor Institute Tuesday. (Karen Schiely/Akron Beacon Journal)

The massive changes happening within the medical industry are creating new job opportunities for people with new types of skills.

That was the message shared by local health-care leaders during a panel discussion Tuesday at the University of Akron.

“I think it’s a wonderful time to be exploring a career in the health-care profession,” Charles T. Taylor, dean of the College of Pharmacy at Northeast Ohio Medical University, said to the group of University of Akron students and faculty.

The discussion, Healthcare Careers after the Implementation of the Affordable Care Act, was part of the University of Akron College of Business Administration’s H. Peter Burg Personal Leadership Development Speaker Series.

The series was created last year to give students an opportunity to learn from local business and community leaders.

The Affordable Care Act, commonly known as Obamacare, is a starting point in the much-needed transition from a health-care system that focuses on “sick care” rather than keeping people healthy, said Martin Hauser, chief executive of SummaCare insurance company.

People with data analysis skills are in demand within the health-care industry as quality becomes increasingly important, Hauser said. “We’ve been hiring lots of people with data and informatics backgrounds.”

Doctors, nurses, patient advocates and other staff members who didn’t used to talk regularly now have daily “huddles” to talk about what is happening in each unit, said William Considine, president and chief executive of Akron Children’s Hospital. “It’s now becoming commonplace.

“The whole concept of team has been redefined in health care.”

Pharmacists have new opportunities to become a more integral part of the health-care team, Taylor said. Pharmacists can use their skills to help patients with medication management and compliance.

“Medications are obviously a key piece of primary care,” he said.

Patient navigators who help those with breast cancer, prostate cancer or other serious illness coordinate all their appointments and care in a move that is becoming more common, said Beverly Bokovitz, Akron General Medical Center’s chief nursing officer.

Advanced practice nurses also are in demand “to take care of families in a more cost-effective, quality way,” Considine said.

Faced with financial challenges, health-care systems are seeking employees with experience in project management or “lean” efforts used by the manufacturing industry to improve efficiency, Hauser said.

Considine acknowledged in an interview after the panel discussion that financially challenging times have resulted in some “right sizing” within the hospital industry.

This fall, Summa Health System and Akron General both laid off workers as part of ongoing efforts to reduce expenses and contend with changes from federal health-care reform. The Cleveland Clinic also recently told employees that staff cuts could be part of the Northeast Ohio health-care giant’s plans to reduce costs by $330 million in 2014.

However, Considine said, hospitals are continuing to hire in new and expanding areas, such as outpatient services.